Priority Research Centre for Reproductive Science, School of Environmental and Life Sciences, The University of Newcastle, Callaghan, NSW, Australia.
Infertility and Reproduction Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Front Endocrinol (Lausanne). 2023 Feb 22;14:1145533. doi: 10.3389/fendo.2023.1145533. eCollection 2023.
Male infertility is a commonly encountered pathology that is estimated to be a contributory factor in approximately 50% of couples seeking recourse to assisted reproductive technologies. Upon clinical presentation, such males are commonly subjected to conventional diagnostic andrological practices that rely on descriptive criteria to define their fertility based on the number of morphologically normal, motile spermatozoa encountered within their ejaculate. Despite the virtual ubiquitous adoption of such diagnostic practices, they are not without their limitations and accordingly, there is now increasing awareness of the importance of assessing sperm quality in order to more accurately predict a male's fertility status. This realization raises the important question of which characteristics signify a high-quality, fertilization competent sperm cell. In this review, we reflect on recent advances in our mechanistic understanding of sperm biology and function, which are contributing to a growing armory of innovative approaches to diagnose and treat male infertility. In particular we review progress toward the implementation of precision medicine; the robust clinical adoption of which in the setting of fertility, currently lags well behind that of other fields of medicine. Despite this, research shows that the application of advanced technology platforms such as whole exome sequencing and proteomic analyses hold considerable promise in optimizing outcomes for the management of male infertility by uncovering and expanding our inventory of candidate infertility biomarkers, as well as those associated with recurrent pregnancy loss. Similarly, the development of advanced imaging technologies in tandem with machine learning artificial intelligence are poised to disrupt the fertility care paradigm by advancing our understanding of the molecular and biological causes of infertility to provide novel avenues for future diagnostics and treatments.
男性不育是一种常见的病理情况，据估计，在寻求辅助生殖技术的夫妇中，约有 50%的夫妇存在这种情况。在临床表现中，这些男性通常会接受传统的诊断性男科实践，这些实践依赖于描述性标准，根据精液中遇到的形态正常、能动精子的数量来定义他们的生育能力。尽管这种诊断实践已经得到广泛应用，但它并非没有局限性，因此，人们现在越来越意识到评估精子质量的重要性，以便更准确地预测男性的生育能力。这一认识提出了一个重要的问题，即哪些特征标志着高质量、受精能力强的精子细胞。在这篇综述中，我们回顾了近年来对精子生物学和功能的机制理解的进展，这些进展为诊断和治疗男性不育症提供了越来越多的创新方法。特别是，我们回顾了实现精准医学的进展；尽管在生育领域，其在临床上的应用远远落后于其他医学领域，但这种方法已经得到了广泛的认可。尽管如此，研究表明，应用先进的技术平台，如全外显子组测序和蛋白质组分析，通过揭示和扩展我们的候选不育生物标志物库存，以及与反复妊娠丢失相关的生物标志物，在优化男性不育症管理方面具有很大的应用前景。同样，先进的成像技术与机器学习人工智能的结合，有望通过深入了解不孕的分子和生物学原因，为未来的诊断和治疗提供新途径，从而颠覆生育保健模式。
